Question

1. A 32-year-old woman is seen in the emergency department complaining of a severe headache and nausea. She reports a history of headaches off and on for the past several months, typically unilaterally and without warning. In addition, she reports that the headaches occur at varying times of the day. A. Based on this brief history, the physician suspects that the woman may suffer from:

A. CPH

B. Tension type headaches (TTHs)

C. Migraine headaches

D. Cluster headaches

2. A few months later, the woman suffers another severe headache and attempts to drive herself to the emergency department when she crosses into oncoming traffic, causing a motor vehicle accident. She is transported via emergency medical services (EMS) to the emergency department. She remains unconscious and responds to painful stimulation with extension of her extremities and a cervical collar for immobilization in place. Her Glasgow coma scale (GCS) rating is 4. Emergency department personnel note that she has blood coming from her nose, bruising around both eyes, and dilated pupils. A computed tomographic (CT) scan shows a subdural hematoma and air in the sinuses. B. These symptoms suggest:

A. Temporal lobe herniation

B. Blunt trauma

C. Tertiary injury

D. Contrecoup injury

Answer 1

Answer for q 1is option C: The woman is having migraine headache.

• Option A: CPH is chronic paroxysmal headache, in this the patient will have unilateral headache on one side of the cranium around the eyes but there is no neurological symptoms. The patient suffers from headache for several times a day and lasts for 5 to 30 minutes. There will be watering of eyes, no nausea and vomiting.
• Option B: Tension type headache is when neck and scalp muscles become tensed. There will be pressure like, dull pain, felt all over, not unilateral. Pain may occur daily and last for 30 minutes to 7 days. There is no nausea and vomiting. It is triggered by some factors like noise, light, stress, etc.
• Option C: Migraine headache is the commonest problem seen in the emergency department. It lasts fom 4 to 72 hours, occurs daily. 80% of cases don't experience aura. The pain is present on one side, throbbing in nature. Patient will have nausea and sometimes vomit. Some become sensitive to sound and light.
• Option D: Cluster headache occurs on one side of head, typically around the eyes. The patient will complain of tearing eyes, swelling around eyes and nasal congestion. It lasts for 15 minutes to 3 hours and for weeks, months and may be a year too.

Answer for q 2 is option A: The woman is having temporal lobe herniation.

• Option A: Temporal lobe herniation is caused due to trauma where there is a shift in the brain and cerebrospinal fluid. The patient will have headache, loss of consciousness and dilated pupils. The CT scan will show subdural hematoma that is bleeding under the brain surface.
• Option B: Blunt trauma is due to impact, injury or physical attack. There will be contusions, abrasions, lacerations and bone fractures.
• Option C: Tertiary injuries are due to explosions where the person is thrown against a physical object. It is usually present along with combination of blunt or penetrating trauma.
• Option D: Contrecoup injury is due to opposite injury from direct impact. There is loss of consciousness but the pupils are not dilated. They are sensitive to light.